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The 'true purpose' of the medical profession is the sublimated utilization of the impulse of reparation. The anxieties and unresolved conflicts of the physician produce countertransference problems which in turn interfere with this 'true purpose'. The anlage of these conflicts can be seen in the childhood 'doctor game' and its derivatives, which represent attempts at actively mastering these conflicts. These attempts at active mastery are also reflected in some of the institutionalized aspects of the practice of medicine, such as the submissive role and magical expectations of the patient vis-à-vis the doctor. All of these mechanisms are seen as means of avoiding threatening aspects of an emotional participation of the doctor in the relationship with the patient. The 'bad patient', who is not submissive and who does not docilely fall into clearcut categories, is especially liable to upset these defensive mechanisms and mobilize countertransference reactions in the physician. The author describes the possibility of 'depressive identification with the destroyed object' as the basis of exaggerated compassion and pity on the part of the physician for his patient.